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Suicide awareness for nurses is just as important as basic life support

Better education and awareness, both as part of nursing degree courses and afterwards on the job, are vital.

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Nurses can play an important part in helping to prevent suicide, but aren’t always being given the training they need to do so at present.

That’s the message from the Royal College of Nursing’s Mental Health Forum as nursing staff debate the issue at the RCN’s annual Congress today as members call for better education and awareness – both as part of nursing degree courses and afterwards on the job.

The debate follows the suicide of one of the male characters in Coronation Street last week, in a harrowing episode watched by over seven million viewers.

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This week is Mental Health Awareness Week.

The leading cause of death for men under 45.

Almost 6,000 people took their own lives in the UK last year, and suicide is the leading cause of death for men under 45.  Only a third of those ending their lives were known to mental health services.  However, many of the other two-thirds will have come into contact with other health professionals such as nurses and GPs – meaning that nursing staff have opportunities to try and help prevent suicides.  But a previous survey by the College found that half of nurses hadn’t received any training in suicide prevention or awareness since starting work, while 60 percent hadn’t received any as part of their nursing degree.

In March, the Nursing and Midwifery Council confirmed that the recognition and assessment of suicide and self-harm should be included in nursing degree courses, partly as a result of lobbying by the RCN.  Now the College’s Mental Health Forum is calling on all higher education institutions to implement this new standard as soon as possible, and for this training to continue for all nurses, not just those in mental health, once they start working.

The 4,000 nursing staff attending the RCN’s annual Congress, taking place this year in Belfast, will today debate ways to improve suicide awareness within nursing.  The NHS’s National Director for Mental Health, Claire Murdoch, is also highlighting the importance of nursing in suicide prevention.

An issue every professional will need to deal with.

Tim Coupland, mental health nurse and RCN Mental Health Forum member who is the proposer of today’s debate, said: “At some point during our working lives, every health professional will come into contact with someone who is feeling suicidal.  We all need the confidence to be able to talk frankly and openly with patients about how they are feeling, in order to let them know we can support and help them.  But I know that many nurses are worried about what to say in these situations, what to do, how to phrase their response, when to share and when to step in – realising that someone is suicidal is disturbing, and it often feels easier to play down the idea or perhaps quickly pass it to a mental health professional. 

“In last Wednesday’s Coronation Street, a leading character took his own life.  I applaud the fact that the producers of the programme worked with the charities Samaritans and CALM [the Campaign Against Living Miserably] to ensure that the way the story was told tried to encourage people who hide their feelings of desperation the chance to start a conversation with others. 

“We want all universities offering nursing degrees to include training in this vital area in their courses as soon as possible, and for employers to offer on-the-job training too.  Suicide awareness and intervention should be as fundamental to nursing staff as basic life support – your intervention, your response, could literally save a life”.

So much more can be done.

Claire Murdoch, National Mental Health Director for England, added: “Even though we know suicides overall are reducing, there is so much more that can be done.  We still need to believe that these deaths are preventable, and nurses are ideally placed to be leading the way.  We need high ambitions in our work to significantly reduce deaths by suicide – all of us should be well trained, be able to recognise the signs, as well as support and signpost a person.  In many cases one conversation at the right time, in the right way, could save a life and be life- changing”.

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Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Nurse with patient in bed

Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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